Provider Demographics
NPI:1972568582
Name:PIEDMONT PODIATRY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PIEDMONT PODIATRY ASSOCIATES, PLLC
Other - Org Name:PIEDMONT FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:PODIATRY
Authorized Official - Phone:336-627-4861
Mailing Address - Street 1:519 S VAN BUREN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5070
Mailing Address - Country:US
Mailing Address - Phone:336-627-4861
Mailing Address - Fax:336-623-4411
Practice Address - Street 1:519 S VAN BUREN RD
Practice Address - Street 2:SUITE D
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5070
Practice Address - Country:US
Practice Address - Phone:336-627-4861
Practice Address - Fax:336-623-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU02680Medicare UPIN
NCT64034Medicare UPIN
NC0611010002Medicare NSC